Cost of Prescription Drug-Related Morbidity and Mortality

Background: The role of primary care in the prevention and management of chronic diseases has become a pillar of healthcare to improve overall population-health outcomes and to address the ongoing growth of healthcare spending. The breadth of medication-related cost beyond baseline drug pricing has become increasingly concerning. Medication morbidity and mortality, including non-adherence to medications, was estimated at approximately 13% of healthcare spending in 2008 as a result of non-optimized medication use. With the significant changes in the healthcare system since this analysis and the increased attentiveness to drug cost, an updated estimation of medication related costs would provide a cornerstone to drive healthcare related reform and help align efforts to reduce costs associated with medication use. This article aimed to update the estimated cost of medication-related morbidity and mortality resulting from non-optimized medication therapy from a third-party payer perspective.

Methods: Total costs of non-optimized prescription drug use and average pathway costs for a patient who experienced a treatment failure (TF), a new medical problem (NMP), or a TF and NMP were modeled based on probability pathways previously published in the literature.

Results: The estimated annual cost of prescription drug–related morbidity and mortality resulting from non-optimized medication therapy was $528.4 billion in 2016 US dollars, ranging from a minimum of $495.3 billion to a maximum of $672.7 billion when utilizing lowest and highest estimations of hospitalization costs, respectively. Based on information gathered from the decision-analytic model used, estimated cost of a physician encounter was an average of $850 (range of $792 to $902) when incorporating costs of patients receiving no drug therapy, successful drug therapy, and downstream costs of non-optimized drug therapy. The average cost of an individual experiencing NMP from non-optimized drug therapy was estimated to be highest at $2610 (range from $2374 to $2848) compared to TF, or a combination of TF and NMP, at $2481 (range from $2233 to $2742) and $2572 (range from $2408 to $2751), respectively.

Conclusions: The updated annual cost of drug-related morbidity and mortality from non-optimized medication use of $528.4 billion is 16% of total US health care expenditures in 2016, compared to 8% and 13% in 1995 and 2008, respectively. Although this estimate does account for overall price inflation, it does not include non-medical or indirect cost, such as caregiver expenses or lost productivity, which have been estimated to be more than the direct medical cost alone for many prevalent chronic diseases.

Factors including the increasing Medicare population and the growing utilization of specialty drugs will continue to drive medication related costs. Costs for prescription drugs for major disease categories, home health services, and medical resources (eg ED visits, hospitalizations, etc) are expected to accelerate between 2018 and 2025.

Study authors conclude that reducing these utilization costs will require a systematic approach to medication management to reduce the number of patients experiencing TF, NMP, or TF and NMP resulting from non-optimized medication therapy. Comprehensive medication management (CMM) focused on achieving optimal clinical and patient centered goals of therapy is becoming recognized as a cornerstone of delivery and payment reform efforts. The collaboration of clinical pharmacists with the rest of the healthcare team will be increasingly relied upon to make real-time drug therapy decisions. Utilizing CMM is an effective way to resolve drug therapy problems with the shortage of primary physicians and support other specialty areas, such as behavioral health, where medications are having a growing role.

Expansion of CMM programs can help reduce the avoidable medical costs associated with non-optimized medication use and improve overall patient care.